Field of the Invention
This relates generally to methods for making surgical incisions using scalpels and related surgical devices. More particularly this relates to devices and methods that facilitate improved surgeries, such as breast surgeries, and specifically, the incisions involved therein.
Description of Related Art
For a variety of reasons including the prevalence of breast disease and the practical or other basis for cosmetic or corrective operations, breast surgeries have increased in number. For example, in 2011, patients underwent almost 100,000 breast reconstruction surgeries, more than 63,000 breast reduction surgeries, and over 90,000 mastopexies. In addition to these large numbers of surgeries, other breast-related surgeries were performed, including areolar reduction surgeries, the number of which is not easily ascertained.
One aspect that most if not all of these surgeries share is the need for circular incisions, for example to move the nipple and related tissue(s) and/or to provide for optimal healing and cosmetic results. Given the relative prevalence of such surgeries, common practices have become fairly standard. Typically a surgeon makes two substantially circular incisions. Ideally these incisions would be perfectly circular. However, drawing a perfect circle by hand is difficult if not impossible even for a gifted artist. Cutting a perfect circle with a standard scalpel, under the conditions present during the course of surgery is even more challenging. The surgeon works on an uneven surface, i.e. the patient, and must make his circular incision on areas having varying surface properties, firmness, density, and consistency, in addition to other properties that affect how a particular tissue or region of tissue will respond to the surgeon's efforts.
In the case of breast surgeries, these circular incisions can serve to preserve the blood supply to the patient's nipple as well as to facilitate the future placement of the nipple.
During breast reductions or mastopexies, a first circular incision is made as follows: methylene blue ink is brushed onto an areolotome, e.g. with a cotton swab. The areolotome is then used to mark a circular path around the patient's nipple. The diameter of the circular path corresponds to the desired size of the new nipple. The areolotome is then removed and a standard scalpel is used to cut along the marked path.
After the initial incision, the nipple and its underlying tissue/blood supply is freed from the enveloping skin. Any excess skin and/or breast tissue is removed and the nipple is repositioned. The remaining skin is draped over the nipple.
A second circular incision allows the nipple to come through the breast skin in its new position. The areolotome is again brushed with methylene blue ink. It is then placed on overlying breast skin above the nipple in order to mark the new position of the nipple. Finally, the areolotome is removed and a standard scalpel blade is used to cut along the circular marked path. The skin within the marking is discarded and the nipple is brought through the hole into its new position. It is then sutured to the surrounding skin.
These incisions are extremely important, as the circular nipple area that has been incised and remains intact forms the patient's post-surgery nipple, which is placed in the circular area of the second incision. The accuracy and precision of the circularity and matching of these two circular incisions are of utmost importance to the final post-operative healing and appearance of the breast and the nipple. Any imperfections, deviations, or errors in these incisions can lead in the worst cases to improper or delayed healing, scarring, or deformity of the patient's nipple and breast (including risk of nipple twisting or loss of the nipple), or in the best case only to a less desirable aesthetic result of the breast surgery.
There is a need for alternative and improved methods to make these incisions.